Katie Knight: “Diva Doctors” and the problem with gendered language in medicine

Mariah Carey demanding two peoples’ assistance to be lowered safely onto a sofa. J-Lo refusing to use any toilet seat other than the one that was custom-made for her famous behind. Beyonce insisting Blue Ivy’s nursery is scented with rose petals and heated to exactly 26.5 degrees. Whether there’s any truth in these celebrity flights of fancy, the demands of a “diva” are outrageous, and outrageously publicised.

The official definition of a diva is a highly distinguished—usually operatic—female singer. In more colloquial use, calling someone a “diva” is shorthand for saying that they are high maintenance, must be at the centre of attention at all times, and care little about the feelings of others. “Diva” is a gendered word—nearly always used in the context of describing a woman, or a woman’s behaviour. A word in itself is neither good or bad, but when it has such loaded associations, the messages that a single word sends can be damaging. 

The General Medical Council (GMC) recently published a piece of research they had commissioned, titled “How doctors in senior leadership roles establish and maintain a positive patient-centred culture.” In this report, medical ethics consultant Suzanne Shale calls out five “harmful subcultures” within clinical teams—with the intention of helping senior leaders overcome these challenges. This is a step in the right direction for the GMC’s engagement with leadership improvement work and its attempts to support culture change at a systems level. However, the decision to name one of the harmful subcultures the “Diva” subculture needs to be challenged.

This subculture is apparently one in which “powerful and successful professionals are not held to account for inappropriate behaviour.” There is no mention of this being aimed specifically at women in this context, but the use of a gendered term means that women are automatically called to mind. Gendered language is often used to belittle women or control their behaviours—even when the same behaviours from a man are seen as a positive trait. The woman who is called “bossy” for asking her medical team to do something in a particular way, versus the man who is applauded for being “assertive” when he does the same. The woman chief executive who raises her voice in a meeting is derided as being “strident” whereas a man in the same situation is called “passionate.”

These are damaging things to hear. They can subconsciously affect womens’ self image and send the message that women are not welcome in these environments, or worse, not suitable for these roles. Every word used to describe someone has power behind it.

In the current NHS managerial landscape where only 37% of Foundation Trust directors are women (despite women making up 77% of the NHS workforce as a whole), the women aspiring to a career in NHS leadership do not need to hear another derogatory gendered word used to describe a dysfunctional leadership culture. 

Ironically, the main finding of the GMC’s report is that “good leadership and positive cultures are vital to health care and patient safety.” We know that a positive culture is very much dependent on valuing and encouraging diversity at all levels of leadership. Our words have power, and we must choose them wisely. We need to start these conversations with a language of inclusion, not one of alienation.

Katie Knight, Paediatric Emergency Medicine Consultant, London, and 2018-19 National Medical Director’s Clinical Fellow.

Competing interests: Katie Knight is one of the co-founders of Women Speakers in Healthcare